HHS UPDATED OPIOID GUIDANCE
HHS released a Guide of WHEN, HOW, and IF it's appropriate to TAPER opioid pain medications.
PLEASE DO NOT instantly decide this is negative!
Finally the CORRECT (parent) agency, HHS is speaking out and setting OFFICIAL guidelines that will set the PRECEDENT for best practices.
HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to COLLABORATE with patients on deciding how fast they reduce or stop their opioid therapies.
"We know that it is CRITICAL that clinicians manage acute and chronic pain in an INDIVIDUALIZED, patient-centered way"
This allows us to report those who do not taper appropriately, for legitimate reasons, or in collaboration with the patients wishes.
✅ This is the First OFFICIAL GUIDE that lists requirements for OUD and acknowledges that tolerance & withdrawal do not equal sufficient criteria to diagnose us with OUD. Thus the beginning of decriminalizing ‘physical dependence’ on a national level! Most documents & definitions omitted that little caveat, leading to many incorrect OUD diagnoses in pain patients.
✅ It mentions that some patients on BOTH benzos and opioids DO NOT need to be tapered.
✅ More than 1/2 of the references are studies that support us, which means they can no longer say we do not have good info to PROVE HARMS of tapering.
✅ It reiterated that CDC limits should NEVER be used as STATE LAW/POLICY to deny or taper patients. Also mentions insurance and pharmacies have increasingly caused patients to be cut off abruptly, hopefully that will be addressed soon!
This finally gives us an idea of how many on LTOT (Long Term Opioid Therapy) - 8,100,000 or 4% of the population. Remember that we ARE the MINORITY needing higher doses over 90mme.
Even the flow chart says to only taper if risks outweigh benefits, and to re-evaluate every 3 months, that could reduce the number of appointments for many!
✅ Another HUGE thing is that it also says before tapering, there needs to be ACCESS to EFFECTIVE and AFFORDABLE alternatives. For many of us that does not exist, so it could also protect from forced tapers!
Common tapers range from reducing opioids dosage between 5% and 20% every four weeks, but HHS recommends reducing dosage by 10% per month or slower for patients who have used opioids for more than a year.
Most of all, it sets a standard that should greatly REDUCE the number of forced, rapid tapers and abandonment because this guide could be used AGAINST prescribers & medical boards that encourage prescribers to ignore this guidance!
"Clearly, we believe that there has been a misinterpretation of the [CDC] guidelines, which were very clear," Giroir said. "People have inappropriately misinterpreted cautionary dosage thresholds as mandates for dose reduction." Giroir said.
Summary:
HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to collaborate with patients on deciding how fast they reduce or stop their opioid therapies.
"We know that it is critical that clinicians manage acute and chronic pain in an individualized, patient-centered way," Giroir said.
There have been numerous reports of individuals being abruptly cut off their medication regimen after the Centers for Disease Control and Prevention's Guideline for Prescribing Opioids for Chronic Pain in 2016, according to Giroir.
The CDC guidelines recommended clinicians prescribe opioids only after exhausting other pain therapies, prescribe the lowest effective dosage, evaluate patients within 1 to 4 weeks of starting opioid therapy for chronic pain, and taper or discontinue opioids if the harms OUTWEIGH the benefits.
"Clearly, we believe that there has been a misinterpretation of the [CDC] guidelines, which were very clear," Giroir said. "People have inappropriately misinterpreted cautionary dosage thresholds as mandates for dose reduction."
News Reports:
HHS Warns Doctors To Not Swing Too Far On Pendulum Away From Opioids For Chronic Pain Patients
As the country grapples with the opioid epidemic, there's been a broad crackdown on opioids in general. Now, HHS is urging doctors not to go too far in cutting off prescriptions.
The Associated Press: US Urges Shared Decisions With Pain Patients Taking Opioids
U.S. health officials again warned doctors Thursday against abandoning chronic pain patients by abruptly stopping their opioid prescriptions. The U.S. Department of Health and Human Services instead urged doctors to share such decisions with patients. The agency published steps for doctors in a six-page guide and an editorial in the Journal of the American Medical Association. (Johnson, 10/10)
The New York Times: Health Officials Urge Caution In Reducing Opioids For Pain Patients
After more than 300 medical providers, pharmacists, patient advocates and others emphasized these concerns in a letter to the C.D.C. earlier this year, the agency put out a clarifying statement saying the guidelines did not “support abrupt tapering or sudden discontinuation of opioids,” and warning doctors not to misapply them. The new tapering guide goes deeper, detailing the potential harms to patients who abruptly stop taking opioids and laying out factors to consider and steps to take before starting a taper. It includes several examples of tapering protocols. (Goodnough, 10/10)
NPR: Don't Force Patients Off Opioids Abruptly, New Guidelines Say, Warning Of Severe Risks
"It must be done slowly and carefully," says Adm. Brett P. Giroir, MD, assistant secretary for health for HHS. "If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way." This is a course correction of sorts. In 2016, the Centers for Disease Control and Prevention issued prescribing guidelines. Those highlighted the risks of addiction and overdose and encouraged providers to lower doses when possible. In response, many doctors began to limit their pain pill prescriptions, and in some cases cut patients off. (Stone and Aubrey, 10/10)
The Washington Post: New Guidelines On Opioid Tapering Tells Doctors To Go Slow
Millions of people in the United States — an estimated 3 to 4 percent of the adult population — take opioids daily. About 2 million people have been diagnosed with prescription opioid use disorder, according to HHS. There is a consensus in the medical community that these painkillers have been overprescribed and that many patients would have better long-term health outcomes if they cut back on their dosages and took advantage of other types of treatment, ranging from physical therapy to nonnarcotic painkillers. (Achenbach, 10/10)
Modern Healthcare: HHS Gives Physicians Guidance On Tapering Patients Off Opioids
HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to collaborate with patients on deciding how fast they reduce or stop their opioid therapies. "We know that it is critical that clinicians manage acute and chronic pain in an individualized, patient-centered way," Giroir said. (Johnson, 10/10)
The anxiety around prescribing built in response to the opioid crisis, which drove more than 47,000 fatal overdoses in 2017 alone. The crisis was caused in part by some clinicians overprescribing the drugs, leading to cases of addiction in patients and a source of pills that were diverted. Prescribing levels have dropped since 2012, and some advocates have warned that the fear around opioids has left some patients unable to get them. (Joseph, 10/10)
PAIN MANAGEMENT TASK FORCE
Pain Management Task Force Issues Final Report on Best Practices for Treatment of Pain
The Pain Management Best Practices Inter-Agency Task Force, a federal advisory committee established by the Comprehensive Addiction and Recovery Act of 2016 - PDF, today released its final report on acute and chronic pain management best practices, calling for a balanced, individualized, patient-centered approach.
To ensure best practices for the treatment of pain, the Task Force final report underscores the need to address stigma, risk assessment, access to care and education. It also highlights five broad categories for pain treatment: medications, interventional procedures, restorative therapies, behavioral health, and complementary and integrative health approaches.
“There is a no one-size-fits-all approach when treating and managing patients with painful conditions,” said Vanila M. Singh, M.D., MACM, Task Force chair, and chief medical officer of the HHS Office of the Assistant Secretary for Health. “Individuals who live with pain are suffering and need compassionate, individualized and effective approaches to improving pain and clinical outcomes. This report is a roadmap that is desperately needed to treat our nation’s pain crisis.”
The Task Force was created in the midst of a national opioid epidemic, but also at a time when an estimated 50 million adults in the United States experience chronic daily pain. As such, the report emphasizes safe opioid stewardship by recommending more time for history-taking, screening tools, lab tests, and clinician time with patients to establish a therapeutic alliance and to set clear goals for improved functionality, quality of life, and activities of daily living. Medication disposal and safe medication storage are also emphasized for patient safety.
The report includes a section highlighting disparities and unique challenges faced by special populations, including veterans, active military, women, youth, older adults, American Indians and Alaska Natives, cancer patients and those in palliative care, and patients with sickle cell disease and other chronic, relapsing painful conditions.
The Task Force has 29 members, representing federal and non-federal entities with diverse disciplines and views. It is overseen by the U.S. Department of Health and Human Services, in cooperation with the U.S. Department of Veterans Affairs and the U.S. Department of Defense. The Task Force members have significant public- and private-sector experience across disciplines, including pain management, patient advocacy, substance use disorders, mental health, veteran health, and minority health.
The Pain Management Best Practices Inter-Agency Task Force (Task Force) was established to propose updates to best practices and issue recommendations that address gaps or inconsistencies for managing chronic and acute pain, The Final Report on Best Practices: Updates, Gaps, Inconsistencies and Recommendations - PDF.
The U.S. Department of Health and Human Services oversaw this effort with the U.S. Department of Veterans Affairs and U.S. Department of Defense.The Task Force, which was authorized by section 101 of the Comprehensive Addiction and Recovery Act of 2016 - PDF, also provided the public with an opportunity to comment on any proposed updates and recommendations and developed a strategy for disseminating information about best practices.
The Task Force consisted of representatives from relevant HHS agencies, the Departments of Veterans Affairs and Defense and the Office of National Drug Control Policy. Non-federal representatives included individuals representing diverse disciplines and views, including experts in areas related to pain management, pain advocacy, addiction, recovery, substance use disorders, mental health, minority health and more. Members also included patients, representatives from veteran service organizations, the addiction treatment community and groups with expertise in overdose reversal, including first responders, medical boards and hospitals.
The charter for the Task Force was approved by the Secretary of Health and Human Services on October 24, 2017 and sunset on July 22, 2019.